Reflux Disease in Singers: A Systematic Review.

Laryngeal—Otolaryngology—Otorhinolaryngology—Voice—Laryngopharyngeal—Reflux—Singing— Singer—Professional—Dysphonia—Hoarseness; Otorhinolaryngology; Speech and Hearing; LPN and LVN

Abstract :

[en] [en] OBJECTIVE: To investigate the laryngopharyngeal reflux disease (LPRD) features in singers. METHODS: According to the PRISMA statements, two investigators searched the literature related to the prevalence of symptoms, findings, and clinical therapeutic outcomes of reflux in singers through a PubMed, Scopus, and Cochrane Library systematic review. RESULTS: Of the 91 identified studies, 18 publications met the inclusion criteria, accounting for 2288 singers and 1398 controls, respectively. There were 1243 (54.3%) professional singers, 450 (19.7%) amateurs, 329 (14.4%) singing students, and 102 (4.5%) singing teachers. The LPRD diagnosis and findings were based on objective evaluations in 2/18 studies. According to validated and unvalidated patient-reported outcome questionnaires, reflux symptoms have been found in 25.0% to 65% of singers, with a RSI > 13 in 25.0%-33.9% of cases. The prevalence of LPRD signs ranged from 18.1% to 73.4% of singers without voice complaints and 18.1%-73.4% of singers with voice complaints at the time of the evaluation. No study investigated the pretreatment to post treatment changes in symptoms, findings, and voice outcome. Substantial heterogeneity was found between studies for reflux diagnosis, symptom and sign evaluations, singer profiles (musical styles, voice range), and association outcomes. CONCLUSION: The prevalence of symptoms and findings attributed to LPRD can be high in singer populations. However, the nonspecificity of symptoms and findings, the lack of objective reflux testing, and the heterogeneity in the singer profile limit the drawing of valid conclusions for the prevalence of LPRD. Based on the findings collected in this systematic review, the authors proposed a semistructured questionnaire, including key points for primary singer evaluation.

Disciplines :

Otolaryngology

Author, co-author :

Lechien, Jérome ; Université de Mons - UMONS > Faculté de Psychologie et des Sciences de l'Education > Service de Métrologie et Sciences du langage ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Service de Chirurgie

Briganti, Giovanni ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Service de Médecine computationnelle et Neuropsychiatrie

Language :

English

Title :

Reflux Disease in Singers: A Systematic Review.

Publication date :

07 December 2024

Journal title :

Journal of Voice

ISSN :

0892-1997

eISSN :

1873-4588

Publisher :

Elsevier Inc., United States

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S0892199724004156?httpAccept=text/xml

Research unit :

M120 - Service de Chirurgie

Research institute :

Santé

Available on ORBi UMONS :

since 18 December 2024

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Bibliography

Lechien, J.R., Vaezi, M.F., Chan, W.W., et al. The Dubai definition and diagnostic criteria of laryngopharyngeal reflux: the IFOS consensus. Laryngoscope 134 (2024), 1614–1624, 10.1002/lary.31134.
Koufman, J.A., Amin, M.R., Panetti, M., Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg 123 (2000), 385–388.
Lechien, J.R., Saussez, S., Harmegnies, B., et al. Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology. J Voice 31 (2017), 733–752.
Meng, L., Zhang, Q., Meng, J., et al. Correlation between detection results of pepsin in vocal fold polyp tissues and the postoperative efficacy. J Voice 38 (2024), 1200–1206.
Lechien, J.R., Schindler, A., Robotti, C., et al. Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument. Eur Ann Otorhinolaryngol Head Neck Dis 136:3S (2019), S39–S43, 10.1016/j.anorl.2018.08.008.
Cammarota, G., Masala, G., Cianci, R., et al. Reflux symptoms in professional opera choristers. Gastroenterology 132 (2007), 890–898, 10.1053/j.gastro.2007.01.047.
Thompson, M., Tiwari, A., Fu, R., et al. Frame- work to facilitate the use of systematic reviews and meta-analyses in the design of primary research studies. Agency for Healthcare Res Qual, 2012.
McInnes, M.D.F., Moher, D., Thombs, B.D., et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319 (2018), 388–396.
Gyawali, C.P., Kahrilas, P.J., Savarino, E., et al. Modern diagnosis of GERD: the lyon consensus. Gut 67 (2018), 1351–1362, 10.1136/gutjnl-2017-314722.
Burns, P.B., Rohrich, R.J., Chung, K.C., The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128 (2011), 305–310, 10.1097/PRS.0b013e318219c171.
Slim, K., Nini, E., Forestier, D., et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73 (2003), 712–716, 10.1046/j.1445-2197.2003.02748.x.
Lundy, D.S., Casiano, R.R., Sullivan, P.A., et al. Incidence of abnormal laryngeal findings in asymptomatic singing students. J Otolaryngol Head Neck Surg 121 (1999), 69–77, 10.1016/S0194-5998(99)70128-2.
Mavraj, G., Balouch, B., Alnouri, G., Sataloff, R.T., Alternative and complimentary medication use in singers: a pilot survey. J Voice, 2022, 10.1016/j.jvoice.2022.08.021 S0892-1997(22)00261-2.
Heman-Ackah, Y.D., Dean, C.M., Sataloff, R.T., Strobovideolaryngoscopic findings in singing teachers. J Voice 16 (2002), 81–86, 10.1016/s0892-1997(02)00075-9.
Pregun, I., Bakucz, T., Banai, J., et al. Gastroesophageal reflux disease: Work-related disease?. Dig Dis 27 (2009), 38–44, 10.1159/000210102.
Hočevar-Boltežar, I., Šereg-Bahar, M., Kravos, A., et al. Is an occupation with vocal load a risk factor for laryngopharyngeal reflux: a prospective, multicentre, multivariate comparative study. Clin Otolaryngol 37 (2012), 362–368, 10.1111/coa.12006.
Sataloff, R.T., Hawkshaw, M.J., Johnson, J.L., et al. Prevalence of abnormal laryngeal findings in healthy singing teachers. J Voice 26 (2012), 577–583, 10.1016/j.jvoice.2012.01.002.
Robotti, C., Schindler, A., Lechien, J.R., et al. Prevalence of laryngopharyngeal reflux symptoms, dysphonia, and vocal tract discomfort in Amateur choir singers. J Voice 37 (2023), 932–944, 10.1016/j.jvoice.2021.06.024.
Myint, C., Moore, J.E., Hu, A., et al. A comparison of initial and subsequent follow-up strobovideolaryngoscopic examinations in singers. J Voice 30 (2016), 472–477, 10.1016/j.jvoice.2015.06.013.
Nacci, A., Baracca, G., Romeo, S.O., et al. Endoscopic and phoniatric evaluation in singing students. J Voice 33 (2019), 135–142, 10.1016/j.jvoice.2017.10.006.
Lloyd, A.T., Ruddy, B.H., Silverman, E., et al. Quantifying laryngopharyngeal reflux in singers: perceptual and objective findings. Biomed Res Int, 2017, 2017, 3918214.
Lenti, M.V., Cammarota, G., Vidali, F., et al. Reflux symptoms in professional opera soloists. Dig Liver Dis 51 (2019), 798–803.
Loor, A.C., Nedelcuţ, S., Dumitraşcu, D.L., High prevalence of gastroesophageal reflux in vocal opera students. A case-control type study. Med Pharm Rep 93 (2020), 145–149.
Santos, S.S., Montagner, T., Bastilha, G.R., et al. Singing style, vocal habits, and general health of professional singers. Int Arch Otorhinolaryngol 23 (2019), e445–e450.
Nacci, A., Bastiani, L., Barillari, M.R., et al. Reflux Symptom Index (RSI) and Singing Voice Handicap Index (SVHI) in singing students: a pilot study. J Voice 36 (2022), 288.e25–288.e34.
Korn, G.P., Azevedo, R.R., Monteiro, J.C., et al. Difficulty producing high-pitched sounds in singing: correlations with laryngostroboscopy and electromyographic findings. Braz J Otorhinolaryngol 86 (2020), 669–675.
Zuim, A.F., Gerhard, J., Lloyd, A.T., et al. Independence of Vocal Load from vocal pathology across singing genres. J Voice 37 (2023), 294.e15–294.e20.
Campagnolo, A.M., Benninger, M.S., Priston, P., Assunção, A., Dysphonia in performers: prevalence of vocal lesions and voice emergencies in a private otorhinolaryngology practice. J Voice 37 (2023), 415–418.
Nacci, A., Capobianco, S., Mazzoni, L., et al. Development of a new self-assessment tool for laryngopharyngeal refluxscreening in singers (SVHI-12-LPR). Folia Phoniatr Logop 75 (2023), 284–294.
Belafsky, P.C., Postma, G.N., Koufman, J.A., Validity and reliability of the Reflux Symptom Index (RSI). J Voice 16 (2002), 274–277.
Belafsky, P.C., Postma, G.N., Koufman, J.A., The validity and reliability of the Reflux Finding Score (RFS). Laryngoscope 111 (2001), 1313–1317.
Sataloff, R.T., Professional singers: the science and art of clinical care. Am J Otolaryngol 2 (1981), 251–266.
Miller, M.K., Verdolini, K., Frequency and risk factors for voice problems in teachers of singing and control subjects. J Voice 9 (1995), 348–362.
Lechien, J.R., Saussez, S., Nacci, A., et al. Association between laryngopharyngeal reflux and benign vocal folds lesions: a systematic review. Laryngoscope 129 (2019), E329–E341.
Kayalı Dinc, A.S., Cayonu, M., Sengezer, T., Sahin, M.M., Smoking cessation improves the symptoms and the findings of laryngeal irritation. Ear Nose Throat J 99 (2020), 124–127.
Lechien, J.R., Saussez, S., Hopkins, C., Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: a systematic review. Clin Otolaryngol 48 (2023), 501–514.
Eren, E., Arslanoğlu, S., Aktaş, A., et al. Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings. Eur Arch Otorhinolaryngol 271 (2014), 743–747.
Lechien JR. Differential and Additional Diagnoses of Laryngopharyngeal Reflux Disease: A Case-series. In revisions in J Otolaryngol Head Neck Surg, 2024.
Lechien, J.R., Bock, J.M., Carroll, T.L., Akst, L.M., Is empirical treatment a reasonable strategy for laryngopharyngeal reflux? A contemporary review. Clin Otolaryngol 45 (2020), 450–458, 10.1111/coa.13518.
Lechien, J.R., De Marrez, L.G., Hans, S., et al. Digestive biomarkers of laryngopharyngeal reflux: a preliminary prospective controlled study. Otolaryngol Head Neck Surg 170 (2024), 1364–1371.
Lechien, J.R., Hamdan, A.L., Diagnostic value of pepsin measurements in dysphonia attributed to laryngopharyngeal reflux disease. J Voice, 2023, 10.1016/j.jvoice.2023.07.020 Aug 23:S0892-1997(23)00229-1.
Cohen, S.M., Jacobson, B.H., Garrett, C.G., et al. Creation and validation of the Singing Voice Handicap Index. Ann Otol Rhinol Laryngol 116 (2007), 402–406, 10.1177/000348940711600602.
Wang, M., Mo, T., Tan, J., et al. Risk factor-related lifestyle habits of patients with laryngopharyngeal reflux. Ear Nose Throat J 103 (2024), 640–649.